Peahl Alex F, Rubin-Miller Lily, Paterson Victoria, Jahnke Hannah R, Plough Avery, Henrich Natalie, Moss Christa, Shah Neel
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Peahl).
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (Dr Peahl).
AJOG Glob Rep. 2023 Jan 6;3(1):100158. doi: 10.1016/j.xagr.2022.100158. eCollection 2023 Feb.
Social determinants of health significantly affect health outcomes, yet are infrequently addressed in prenatal care.
This study aimed to improve the efficiency and experience of addressing social needs in pregnancy through: (1) testing a digital short-form screening tool; and (2) characterizing pregnant people's preferences for social needs screening and management.
We developed a digital short-form social determinants of health screening tool from PRAPARE (Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences), and a survey to query patients' preferences for addressing social needs. Instruments were administered online to peripartum participants, with equal representation of patients with public and private insurance. We calculated the sensitivity and specificity of the short-form tool vs PRAPARE. Quantitative responses were characterized using descriptive statistics. Free-text responses were analyzed with matrix and thematic coding. Survey data were analyzed by subgroups of historically marginalized populations.
A total of 215 people completed the survey. Participants were predominantly White (167; 77.7%) and multiparous (145; 67.4%). Unmet social needs were prevalent with both the short-form tool (77.7%) and PRAPARE (96.7%). The sensitivity (79.3%) and specificity (71.4%) of the short-form screener were high for detecting any social need. Most participants believed that it was important for their pregnancy care team to know their social needs (material: 173, 80.5%; support: 200, 93.0%), and over half felt comfortable sharing their needs through in-person or digital modalities if assistance was or was not available (material: 117, 54.4%; support: 122, 56.7%). Free-text themes reflected considerations for integrating social needs in routine prenatal care. Acceptability of addressing social needs in pregnancy was high among all groups.
A digital short-form social determinants of health screening tool performs well when compared with the gold standard. Pregnant people accept social needs as a part of routine pregnancy care. Future work is needed to operationalize efficient, effective, patient-centered approaches to addressing social needs in pregnancy.
健康的社会决定因素对健康结果有重大影响，但在产前护理中很少被提及。
本研究旨在通过以下方式提高孕期解决社会需求的效率和体验：（1）测试一种数字简表筛查工具；（2）描述孕妇对社会需求筛查和管理的偏好。
我们从PRAPARE（应对和评估患者资产、风险及经历协议）开发了一种数字简表健康社会决定因素筛查工具，以及一项询问患者对解决社会需求偏好的调查。这些工具在线发放给围产期参与者，公共保险和私人保险患者比例相同。我们计算了简表工具与PRAPARE相比的敏感性和特异性。定量回答用描述性统计进行描述。自由文本回答用矩阵和主题编码进行分析。调查数据按历史上被边缘化人群的亚组进行分析。
共有215人完成了调查。参与者主要是白人（167人；77.7%）且多为经产妇（145人；67.4%）。简表工具（77.7%）和PRAPARE（96.7%）都显示未满足的社会需求普遍存在。简表筛查工具检测任何社会需求的敏感性（79.3%）和特异性（71.4%）都很高。大多数参与者认为让他们的孕期护理团队了解他们的社会需求很重要（物质需求：173人，80.5%；支持需求：200人，93.0%），并且超过一半的人觉得如果有或没有援助，通过面对面或数字方式分享他们的需求都很自在（物质需求：117人，54.4%；支持需求：122人，56.7%）。自由文本主题反映了将社会需求纳入常规产前护理的考虑因素。所有群体对孕期解决社会需求的接受度都很高。
与金标准相比，一种数字简表健康社会决定因素筛查工具表现良好。孕妇接受社会需求作为常规孕期护理的一部分。未来需要开展工作，实施高效、有效、以患者为中心的方法来解决孕期的社会需求。
